LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Sunday, December 18, 2005

Music, dance, and data

We are at Popejoy Hall on the Campus of the University of New Mexico in Albuquerque; about two hours south of our headquarters. Debbie and I are fourth row back, on the left isle. The perfect place to be. The way Popejoy is built you don't want to be in the front row. It is too close to the stage and the stage is too high. You end up with a sore neck and you can't see half the action anyway.

We are here for the Mariachi Christmas. Debbie loves Mariachi music. I love Debbie. Nuff said about why I'm here.

But tonight I get a treat. The dozen plus member Mariachi Nuevo Chapultepec is only half the show. They are doubling up with Ballet Folkorico Paso del Norte--an award winning dance troupe and a state treasure which is celebrating it's 25th anniversary this year. It is a dazzling riot of sound, color, and action. The dancers traditional skirts whirl and spin flashing every color of the rainbow, and occasionally (of course) the dancers legs. The air is full of sounds, the violins, the trumpets, the guitar and the guitarron. The clacking of the dancer's heals, the pounding of their partner's boots. The crowd cheers, claps, whistles and howls like coyotes. It is too much to take in. You don’t know where to turn next; where to rest your eye.

If you've never been to a Mariachi concert you need to understand that it is inactive in a way that would be considered rude in other venues. The crowd calls out to the performers. The musicians spill into the audience. It is rowdy, loud, and a whole lot of fun.

Before coming we went to Mario's on San Padero over on the Northeast side. They call themselves "traditional Italian." They kid themselves. But it is very good American-Italian food.
Tonight I get a huge plate of spaghetti (the only size they serve) with tomato-alfredo sauce. Never heard of it? Me neither. It doesn't even sound good, but oh my God is it ever. I first had it about six months ago, by stealing a taste from my more adventurous mate's plate. And then another taste. And then another. And another. Until my hand was threatened with great bodily harm by a fork.

Now I get my own plate.

Three cups of spaghetti. According to my PDA data base: 120 carbs.
Four ounces of garlic bread: 64 carbs.
Salad: five carbs.
Sauce....your guess is as good as mine. Some spaghetti sauces have lots of sugar, some have very little. What the hell, 15 carbs.

That's 204 carbs. Sounds too scary so I round down to 200. I need 13.5 units of insulin to cover it. Yikes! That sounds like a lot. Most of my meals are covered by less than two units. Well, no point in having all this info if we don't use it. I press deliver....

Several days later...

I'm sitting at my computer with three windows open. I've got CoZmanager, FreeStyle CoPilot, and Guardian Solutions all running simultaneously. I've also got my PDA and my food log on the desk. I'm looking at the effects of the combo bolus I took at Mario's and I have entirely too much information at my disposal.

Years ago, I remember reading that combat pilots flying into Vietnam would start shutting off various systems in their planes as they approached the target. They were suffering "cockpit overload." They had too much information at their disposal. They were getting districted from the main mission; which was flying it to hostile territory, dropping their bombs and getting the hell out with out getting shot down.

I think I just got shot down. I'm overloaded and paralyzed by the shear amount of information at my finger tips. I should 'a turned something off as I entered hostile territory. Instead of delving into the details I sit in a heap. To depressed and overwhelmed to go on. I close the lap top's lid. This can wait for another day....

I sit for a moment, defeated. No, damn it. I’m not going to go down in flames. I open the lap top again. First I close CozManager. No need to have it running once it beams its data to CoPilot. CozManager is fabulous software for programming the pumps, but it is lousy for data analysis. All you can get is a conventional log book. CoPilot will import data from Coz and it is truly some of the best diabetes software made.

The daily combo view is like a well designed aircraft instrument panel. One glace and you can see everything that is going on. The instrument panel shows you how high you are, if you are upside down, right side up, or somewhere in between. It shows you the direction you are going and how fast. Pretty cool. The Daily Combo in CoPilot does the same thing for your food, BG, and insulin. Laid over the back of the screen is a pale green pyramid that represents your basal pattern. On top, laid out over time are the BG sticks connected by orderly (but misleading) straight lines. Below is the carb intake, circles of various sizes to represent how large the carb load is. The Spaghetti dinner at 200 carbs looks like a nuclear explosion compared to my 20 carb breakfast. Rising above the carb explosions are tall bar-graph extensions showing insulin. Dark green for bolus and red for corrections. It is a fabulous graphical interface. It gives you all the data you could ever want in one place. Or it did, anyway, before I got the Guardian. Now she gives me a better and more accurate picture of what the BG is doing throughout the day. But of course that information can’t be imported into CoPilot, nor can Solutions import all the rest of the data from CoPilot. You gotta work with both, but today I’m concentrating more on the graphs in Solutions.

I’m looking at the night of the spaghetti. At the time I took the insulin I was around....well, it is kinda hard to tell looking at the Solutions software. A hundred points of BG takes up about an inch on the vertical scale. They really need to add some thin gray lines at the 27, 50, and 75 points to make it easier to read. Or better still, the day graphs need the feature their modal day has: you can hover the mouse over the trace and it will give you the real number. I’m thinking its looking like 120...maybe lower? I switch back to CoPilot. 111.

Ok, so we start at 111 and it sweeps up to 232 over the next three hours. Nice slope, not too fast. But that is really too high. The insulin is pumping as a combo bolus, 60% on top the rest coming in over the next four hours. After another hour it drops down to 180 and stays there, stubbornly, for hours. In fact it stays just short of 200 until 1am when I take a correction bolus. By the way, flipping back and forth between two days is a cinch with the Medtronic software.
A hour and a half after the correction I’m just above a BG of 100 where it stays until morning. Well, my early AM correction ratio sure looks great, but the spaghetti bolus needs work. I make some notes in my carb diary. Next time we’ll try 250 carbs, as scary as that sounds.

I usually look over my BG and my food log every two weeks or so, searching for over all trends, analyzing BG disasters (most self inflicted), and developing new “recipes.” If I find something I like at a restaurant it usually takes two or three tries for me to work out the real carbs. But then I’ve got them for any time I go back. The Guardian has given me a new way to look at recipes. Before I had gauged success by looking primarily at the two-hour post meal finger stick. Now I can see how a meal has effected the BG waaaaay down stream of the meal.

Very cool, but all this work and thinking about food has made me hungry...I think I’ll fly out to the kitchen and raid the refrigerator.

2 Comments:

Blogger type1emt said...

Wil,
I can relate. (on the carbohydrate overload stuff) Most of my holiday meals (this year) have gone over the 150 carb mark..Scary thing is, sometimes one's blood sugar is better 2 hours after the meal, then it is for a simple 40 carber..
Heidi

7:21 PM  
Blogger Wil said...

Heidi--

Too bad we can't all just eat 200 carb meals all the time. But then we'd all be 400 pounds! Gosh, then we'd be at risk for Type 2 diabetes. (Ok, that was black humor....)

6:11 PM  

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